(a) These Rules, 10A NCAC 27C, 27D, 27E and 27F, set forth
procedures governing the protection of client rights in each public or private
facility that provides mental health, developmental disabilities and substance
abuse services, with the exception of a state-operated facility. In addition
to these Rules, the governing body shall comply with the provisions of G.S.
122C, Article 3, regarding client rights.

(b) A facility that is certified by the Centers for
Medicare and Medicaid Services (CMS) as an Intermediate Care Facility for the
Mentally Retarded (ICF/MR), or a Medicare/Medicaid Hospital or a Psychiatric
Residential Treatment Facility (PRTF) is deemed to be in compliance with the
rules in Subchapters 27C, 27D, 27E and 27F, with the exception of Rules 27C
.0102; 27D .0101; .0303; 27E .0104; .0105; .0108 and .0109.

(c) A facility that is certified as specified in Paragraph
(b) of this Rule shall comply with the following:

(1) use of the definition of physical restraint
as specified in Rule .0102 Subparagraph (b)(19) of this Section;

(a) The definitions contained in this Rule, and the terms
defined in G.S. 122C‑3, G.S. 122C‑4 and G.S. 122C‑53(f) also
apply to all rules in Subchapters 27C, 27D, 27E and 27F.

(b) As used in these Rules, the following terms have the
meanings specified:

(1) "Abuse" means the infliction of
mental or physical pain or injury by other than accidental means, or
unreasonable confinement, or the deprivation by an employee of services which
are necessary to the mental or physical health of the client. Temporary
discomfort that is part of an approved and documented treatment plan or use of
a documented emergency procedure shall not be considered abuse.

(2) "Anti-psychotic medication" means
the category of psychotropic drugs which is used to treat schizophrenia and
related disorders. Examples of neuroleptic medications are Chlorpromazine,
Thioridazine and Haloperidol.

(3) "Basic necessity" means an
essential item or substance needed to support life and health which includes,
but is not limited to, a nutritionally sound balanced diet consisting of three
meals per day, access to water and bathroom facilities at frequent intervals,
seasonable clothing, medications prescribed by a physician, time for sleeping
and frequent access to social contacts.

(4) "Client advocate" means the term
as defined in G.S. 122C‑3. For the purpose of these Rules, a client
advocate may be a facility employee who is not directly involved in the
treatment/habilitation of a specific client, but who is assigned, in addition
to other duties, to act as an advocate for that client.

(5) "Consent" means acceptance or
agreement by a client or legally responsible person following receipt of
information from the qualified professional who will administer the proposed
treatment or procedure. Consent implies that the client or legally responsible
person was provided with sufficient information, in a manner that the client or
legally responsible person can understand, concerning proposed treatment,
including both benefits and risks, in order to make a decision with regard to
such treatment.

(6) "Day/night facility" means a
facility wherein a service is provided on a regular basis, in a structured
environment, and is offered to the same individual for a period of three or
more hours within a 24‑hour period.

(7) "Director of Clinical Services"
means Medical Director, Director of Medical Services, or other qualified
professional designated by the governing body as the Director of Clinical
Services.

(8) "Emergency" means a situation in
which a client is in imminent danger of causing abuse or injury to self or
others or when substantial property damage is occurring as a result of
unexpected and severe forms of inappropriate behavior and rapid intervention by
the staff is needed.

(9) "Exploitation" means the use of a
client's person or property for another's profit or advantage or breech of a
fiduciary relationship through improper use of a client's person or property
including situations where an individual obtains money, property or services
from a client from undue influence, harassment, deception or fraud.

(10) "Facility" means the term as
defined in G.S. 122C‑3. For the purpose of these Rules, when more than
one type of service is provided by the facility, each service shall be
specifically addressed by required policy and procedures when applicable.

(11) "Governing body" means, in the
case of a corporation, the board of directors; in the case of an area
authority, the area board; and in all other cases, the owner of the facility.

(12) "Governor's Advocacy Council for
Persons with Disabilities (GACPD)" means the council legislatively
mandated to provide protection and advocacy systems and promote employment for
all persons with disabilities in North Carolina.

(13) "Intervention Advisory Committee"
means a group established by the governing body in a facility that utilizes
restrictive interventions as specified in Rule .0104 of Subchapter 27E.

(14) "Involuntary client" means an
individual who is admitted to a facility in accordance with G.S. 122C, Article
5, Parts 6 through 12.

(15) "Isolation time‑out" means
the removal of a client for a period of 30 minutes or more to a separate room
from which exit is barred by staff, but not locked, and where there is
continuous supervision by staff, for the purpose of modifying behavior.

(16) "Minor client" means a person
under 18 years of age who has neither been married nor been emancipated by a
decree issued by a court of competent jurisdiction.

(17) "Neglect" means the failure to
provide care or services necessary to maintain the mental or physical health
and well‑being of the client.

(18) "Normalization" means the
utilization of culturally valued resources to establish or maintain personal
behaviors, experiences and characteristics that are culturally normative or
valued.

(19) "Physical Restraint" means the
application or use of any manual method of restraint that restricts freedom of
movement; or the application or use of any physical or mechanical device that
restricts freedom of movement or normal access to one's body, including
material or equipment attached or adjacent to the client's body that he or she
cannot easily remove. Holding a client in a therapeutic hold or other manner
that restricts his or her movement constitutes manual restraint for that
client. Mechanical devices may restrain a client to a bed or chair, or may be
used as ambulatory restraints. Examples of mechanical devices include cuffs,
ankle straps, sheets or restraining shirts, arm splints, posey mittens, and
helmets. Excluded from this definition of physical restraint are physical
guidance, gentle physical prompting techniques, escorting a client who is
walking; soft ties used solely to prevent a medically ill client from removing
intravenous tubes, indwelling catheters, cardiac monitor electrodes, or similar
medical devices; and prosthetic devices or assistive technology which are
designed and used to increase client adaptive skills. Escorting means the
temporary touching or holding of the hand, wrist, arm, shoulder or back for the
purpose of inducing a client to walk to a safe location.

(20) "Protective device" means an
intervention that provides support for a medically fragile client or enhances
the safety of a self‑injurious client. Such devices may include geri‑chairs
or table top chairs to provide support and safety for a client with a physical
handicap; devices such as seizure helmets or helmets and mittens for self‑injurious
behaviors; prosthetic devices or assistive technology which are designed to
increase client adaptive skills; or soft ties used to prevent a medically ill
client from removing intravenous tubes, indwelling catheters, cardiac monitor
electrodes, or similar medical devices. As provided in Rule .0105(b) of
Subchapter 27E, the use of a protective device for behavioral control shall
comply with the requirements specified in Rule .0104 in Subchapter 14R.

(21) "Privileged"
means authorization through governing body procedures for a facility employee
to provide specific treatment or habilitation services to clients, based on the
employee's education, training, experience, competence and judgment.

(22) "Responsible
professional" means the term as defined in G.S. 122C‑3 except the
"responsible professional" shall also be a qualified professional as
defined in Rule .0104 of Subchapter 27G.

(23) "Restrictive
intervention" means an intervention procedure which presents a risk of
mental or physical harm to the client and, therefore, requires additional
safeguards. Such interventions include the emergency or planned use of
seclusion, physical restraint (including the use of protective devices for the
purpose or with the intent of controlling unacceptable behavior), isolation
time-out, and any combination thereof.

(24) "Seclusion"
means isolating a client in a separate locked room for the purpose of
controlling a client's behavior.

(25) "Treatment"
means the process of providing for the physical, emotional, psychological and
social needs of a client through services.

(26) "Treatment/habilitation
plan" means the term as defined in 10A NCAC 27G .0103.

(27) "Treatment or
habilitation team" means an interdisciplinary group of qualified
professionals sufficient in number and variety by discipline to assess and
address the identified needs of a client and which is responsible for the
formulation, implementation and periodic review of the client's
treatment/habilitation plan.

(28) "24‑Hour
Facility" means a facility wherein service is provided to the same client
on a 24‑hour continuous basis, and includes residential and hospital
facilities.

(29) "Voluntary
client" means an individual who is admitted to a facility upon his own
application or that of the legally responsible person, in accordance with G.S.
122C, Article 5, Parts 2 through 5.